Eyeworld Daily News

SUPPLEMENT TO EYEWORLD DAILY NEWS, MAY 6, 2023 | Supported by Alcon 7 Refer to page 8 for Important Product Information about the Alcon products described in this supplement. Hydrus received FDA approval in 2018 for use in combina- tion with cataract surgery in adult patients with mild to moderate primary open-angle glaucoma. The implant is designed to re-es- tablish the natural outflow of aqueous humor by dilating and scaf- folding Schlemm's canal. 4,6 The eyelash-sized implant fits within about 90 degrees of the canal, allowing it to access multiple fluid collector channels. The American Academy of Ophthalmology gave Hydrus a rating of "Moderate Quality, Strong Recommenda- tion" in its 2020 Primary Open-Angle Glaucoma Preferred Practice Patterns, which in the guidelines is the highest combination of quality and recommendation for a MIGS implant. 7 The long-term data from the HORIZON trial also gives Dr. Blieden confidence as a physician. "I like to see robust, long-term data, and we got it with the 5-year HORIZON outcomes. It's nice to prove that we are doing something if we are leaving an implant behind," she said. Intraoperatively, Dr. Blieden said she doesn't leave Hydrus in place unless she is certain it's seated appropriately. She said the whole length of the implant behind the trabecular meshwork with some of the windows should be visible on gonioscopy, and the mouth of the stent should not be over rotated. "If you're in Schlemm's canal, it should glide in with minimal resistance. You should see it advance behind the trabecular meshwork and be able to visualize almost the full length of the implant before removing the gonioprism," she said, adding that a well-placed Hydrus can be seen at the slit lamp using sclerotic scatter. "You'll see it nicely lined up with the circumference of the limbus just underneath the conjunctival insertion." Dr. Blieden said, for her, success with a combined cataract and Hydrus procedure would mean "great visual outcomes with sustained IOP control off medications" or use of fewer medications compared to preop. "Most of my patients are very happy to be off some of their medications for at least a while. The recovery is fairly quick for a glaucoma procedure," Dr. Blieden said of Hydrus. "They feel like they've taken an opportunity to do something at the time of phaco to address the glaucoma." Since she adopted Hydrus into her armamentarium, Dr. Blieden said she has had consistently predictable outcomes. "Ob- viously, I love it when we can get off all drops and maintain a goal IOP, but even if we decrease the drop burden, it's still a win for the patient in the long run to have a break from topical medications, which do carry side effects and toxicity," 8 she said. Editors' note: Dr. Blieden is an associate professor in the Department of Ophthalmology at Baylor College of Medicine in Houston, Texas. She can be contacted at lblieden@gmail. com. *Secondary surgical intervention (SSI) includes trabeculectomy, tube shunt, gel stent, ECP/TSCP, non-penetrating; (9/369 Hydrus and 10/187 CS) References 1. Zhu X, et al. Objective functional visual outcomes of cataract surgery in patients with good preoperative visual acuity. Eye (Lond). 2017;31:452–459. 2. Skiadaresi E, et al. Subjective quality of vision before and after cataract surgery. Arch Ophthal- mol. 2012;130:1377–1382. 3. Zhang N, et al. Prevalence of primary open angle glaucoma in the last 20 years: a meta-analy- sis and systematic review. Sci Rep. 2021;11:13762. 4. Hydrus Microstent Instructions for Use 5. Ahmed IK, et al. Long-term outcomes from the HORIZON randomized trial for a Schlemm's ca- nal microstent in combination cataract and glaucoma surgery. Ophthalmology. 2022;129:742–751. 6. Alcon Completes Acquisition of Ivantis, Inc., Bringing Hydrus Microstent into Its Global Surgical Portfolio. January 10, 2022. www.alcon.com/media-release/alcon-completes-acquisition-ivan- tis-inc-bringing-hydrus-microstent-its-global. 7. Gedde SJ, et al. Primary Open-Angle Glaucoma Preferred Practice Pattern. Ophthalmology. 2021;128:71–150. 8. Inoue K. Managing adverse effects of glaucoma medications. Clin Ophthalmol. 2014;8:903–913. continued from page 5 continued from page 6 eliminating any obstruction to my view associated with previous configurations," Dr. Woodard said. In terms of onboarding the technology, Dr. Woodard said a lot of the planning for surgical flow, footprint, and other adjustments were done on the front end, making the transition less disruptive than he anticipated. He also thought it would take time for him to adjust to operating in a "heads-up" manner, but that wasn't the case. "From the first procedure I did, I was comfortable doing it," he said, adding that other surgeons in the practice with no prior A properly placed Hydrus shows the full length of the implant behind the trabecular meshwork with at least some of the windows visible on gonioscopy. The mouth of the implant should not be over rotated. Source: Peter T. Chang, MD exposure to NGENUITY transitioned to a full OR day using the technology with ease. Editors' note: Dr. Woodard is the medical director at Omni Eye Services in Atlanta, Geor- gia. He can be contacted at LWoodard@OmniEyeAtlanta.com. References 1. Alcon NGENUITY. www.myalcon.com/professional/cataract-surgery/surgical-equipment/ngenu- ity-3d-system. Accessed Feb. 28, 2023. 2. Alcon Data on File, 2016.

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